Mr. Hutton: It is a tempting morsel. I was being a little unfair to the hon. Member for Oxford, West and Abingdon. It always makes me feel good when I am unfair to him; not for any personal reason, but because I find his party's position utterly pathetic. Its claim that the problems of the NHS can be solved by investment alone is not borne out by events; it is not a tenable position.

Dr. Harris: Will the Minister give way?

Mr. Hutton: I shall give way to the hon. Gentleman in a moment. I shall be fair to him because he wants to entertain us with his views.

We must invest, and we are doing so at record levels, but reform is also essential. The reforms that we are implementing through the Commission for Health Improvement are fundamental to challenging poor performance. The sensible way to reform is not by being judgmental, but by using opinions that are informed by the best clinical expertise.

Dr. Harris: It is difficult to respond to all the Minister's remarks in an intervention, and I may seek to catch your eye after he has spoken, Miss Widdecombe.

I shall not be sidetracked out of order by the Minister's invitation to comment on how the NHS is funded. It is possible to believe that the NHS requires more resources, more staff, better staff morale, better retention, functional rather than structural change and an assurance of good quality; I do not demur at any of that. As we discussed earlier, the danger is that the Commission for Health Improvement is allowed to focus only on quality issues associated with end delivery rather than on the directions, resources and policies to which everyone is forced to work. Bad outcomes are glorified; people may think that sacking or replacing a manager is the solution to the problem, when the Minister would acceptI do not blame only himthat other things need to happen. That is what I mean when I say that the focus of blame is on the end resultthe manager who is sackedrather than on other issues that the commission is prevented from tackling by the terms of the Bill.

Mr. Hutton: The commission will need to identify the source of the problem in any particular trust or hospital. In some cases, there may be a need for a change in management, which, if that were the reason for the problem, would be inescapable.

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A failure to address poor performance would depress morale in the NHS more than anything else. One can go to any hospital in the country and talk to nurses, doctors, therapists, cooks and cleaners who will say whether their team, department, trust or hospital is performing well. What turns many of them off is the realisation that, although problems have been identified over a long period, nothing has happened. Providing a poor service is the easiest option; none of this is easy because this is not the easy option.

The hon. Member for Oxford, West and Abingdon always berates us for taking the easy way out. He describes the clause as a way in which to pass blame elsewhere. These are not easy solutions, as anyone who has read the CHI reports and studied their comments on quality of care will immediately understand. We are holding up a mirror to the NHS, and it will show us things with which we shall not be happy. However, it will also show us some fantastic things, and we must give credit where it is due. Such credit is down to the hard work of nurses and doctors, and it is essential that we make that clear. We shall discover uncomfortable things when we hold a mirror up to the NHS. Our responsibility is not to shuffle our feet and say that the situation is too difficult and that if we act, we shall upset and offend people. That is the way to sell the pass on the future of the NHS. The public have high expectations on which they expect us to deliver.

I have said a great deal more than I intended, but the clause is important. I would say that, but it is my genuine belief that this is an essential plank in equipping the CHI with the tools that it needs to do its job properly and broaden its remit and function. If we are to use the independent sector more frequently to provide NHS care, which we will, we must ensure that the NHS gets the highest quality care when it uses those providers. That is the clause's function.

Dr. Harris: I want to make three points. First, I invite the Minister to respond, which I am sure that he will in a moment, to the statement about access to the Prison Service. Secondly, will he clarify which powers he has in mind other than those set out in the intervention orders in sections 84A and 84B of the 1977 Act? The explanatory notes to the clause state:

''Such measures could include the use by the Secretary of State of his powers of intervention under sections 84A and 84B''.

That implies that there may be other undisclosed powers that have not yet been established. Will the Minister cast some light on what those powers might be?

5.45 pm

I do not want to have an endless debate, and I shall not rise to the bait given by the Conservative party's hard-working Liberal Democrat unit, which hunts out quotes from a democratic party conference where we debated future policy.

The third point, which concerns whether the Commission for Health Improvement holds up a mirror to the NHS, is key. We have already established that the commission is unable to comment on resources, which is one of many issues for which I do

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not hold this Government, as opposed to the Government in the previous Parliament, wholly responsible.

The commission will not be allowed to question the terms of reference under which the NHS is working. If, for example, patients are badly treated in terms of quality of care, in that they are not given urgent operations because the Government have decided that the priority is a patient who is stable and not clinically urgent, but who is coming up to a maximum waiting time limitbe that 18 months, 15 months, 12 months or six monthsand patients die while waiting for urgent operations as a result, the Commission for Health Improvement will not be allowed to comment, criticise or analyse the terms of reference, directions and criteria that commissioners and providers have been given by the Government, because the Government have said that it cannot do so. All that is left for it to do is to say that management should have stopped this happening. Management must not do the Government's bidding, and doctors should certainly not do their bidding, when it is a choicethese choices are sometimes difficult, but this one is obviousbetween clinical need and political need.

That dilemma in which managers and clinicians find themselves is one reason why there is such poor morale in the health service. The Government are not the first to have tried this because there are Conservative Members who recognise this problem. We do not have a balanced approach to quality in respect of the powers that the Secretary of State will take from the clause.

I understood the Minister's point, and he made his caseI hope he takes this the right wayeloquently and strongly in his rebuttal of my main point. However, there is nothing here but a straightforward disagreement. He thinks that it is acceptable for the Government to be partly responsible, not necessarily advertently, for bad things happening in terms of quality, and for the Commission for Health Improvement only to recommend that action should be taken against managers who may feel that they were doing the Government's bidding. We will be unable to make further progress with this discussion. I hope, however, that the Minister will accept that I am not saying that the issue is all about resources, staffing or morale, but that a complex mixture of factors are involved in the delivery of poor care or a lack of access to care. The way in which the commission is set up with its veneer of independence will see blame being allocated publicly to individuals through the exercise of these powers, and not to the processes.

A reading of the Kennedy report reveals that the system, not individuals, is responsible for many quality problems. We miss the point when action is taken only against individuals. If one considers the media coverage of the Bristol royal infirmary's problems, the disciplinary action taken, which was similar to that recommended in the clause, against the doctors and management concernedthe General Medical Council was not necessarily wrongmade it appear before the Kennedy report was published that the only issue was surgeons killing babies and managers letting them do so. The Kennedy report,

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which had a much wider remit than I fear the CHI would ever be allowed to have, clearly said that there were system failures, failures from chasing waiting-list initiatives, and a long-standing failure of resources. That is the point that I have been trying to get across.

I feel that we may not agree any further, but I do not want to repeat debates that we had this morning. It is not simply a matter of calling for more resources. To characterise the points that I am makingI feel that I am making them on behalf of people working in the health service, such as clinicians and managersis to bastardise a very important argument, and a point that needs to be put.

Mr. Hutton: I would like to respond briefly to the point that the hon. Gentleman asked me fairly, which I failed to deal with in my rush of enthusiasm to be unkind to him.

The CHI will have access to NHS services wherever they are provided, whether in prisons or elsewhere. We can come back to this issue when we reach clause 21, as my hon. Friend the Parliamentary Under-Secretary of State will be dealing with that part of the Bill. The very simple answer to the hon. Gentleman's question is that it will. We have a much broader disagreement, but I think that the hon. Gentleman should be wary about casting himself in the role of spokesperson for the NHS. There are always two sides to this argument.

The complaint that I hear loudly and clearly when I visit hospitals and speak to people working in the NHS is that they are sick and tired of no action being taken in the event of poor performance. They want us to take that action, and they want it to be done fairly. It is not about blame, and it is not about identifying individuals. I think that it is very important that we have a set of arrangements in place that will allow us to address those persistent and well-documented failures in performance, and that we do so sensibly.

The hon. Gentleman is being over-precious about his wider argument and the way in which he used the Kennedy report to support his argument. The Kennedy report is very clear about what the role of the Secretary of State should be. The appropriate function of the Secretary of State is to set standards, to provide resources, and to set the overall framework within which priorities should be set and delivered. It is also the job of the hon. Gentlemanalong with all hon. Members on both sides of the Houseto engage the Secretary of State so that he is held accountable for the decisions he makes. It is not the responsibility of the CHI to surpass the role of members of this House in holding the Secretary of State to account.